OSKE (OBJECTIVE STRUCTURED KNOWLEDGE EXAMINATION)
COMPREHENSIVE PRACTICE EXAM
OSKE Practice Exam: 75 Questions
Exam Instructions (For Candidates)
This examination consists of 10 stations. You will have a limited time at each station to
review the clinical scenario and answer all associated questions. Answers should be
concise and demonstrate your clinical reasoning. No external resources or collaboration
are permitted.
Station 1: Cardiology – Chest Pain
Scenario: A 58-year-old male presents to the emergency department with substernal
chest pain that began 2 hours ago. He describes it as "heavy" and radiating to his left
arm. He is diaphoretic and nauseous.
1. Question: Based on the initial presentation, list three most likely differential
diagnoses.
o Answer: Acute Myocardial Infarction (STEMI/NSTEMI), Unstable Angina, Aortic
Dissection.
2. Question: What is the single most important diagnostic test to perform
immediately?
o *Answer: 12-lead Electrocardiogram (ECG).*
3. Question: The ECG shows >2mm ST-segment elevation in leads V2-V4. What is
your diagnosis and immediate next step in management?
, o Answer: Diagnosis: Anteroseptal ST-Elevation Myocardial Infarction (STEMI).
Immediate next step: Activate the cath lab for primary Percutaneous Coronary
Intervention (PCI) or administer thrombolytics if PCI is not available.
4. Question: List two cardiac enzymes used to confirm myocardial necrosis and their
typical peak timing.
o *Answer: 1. Troponin I/T (peaks at 12-24 hours). 2. CK-MB (peaks at 24 hours).*
5. Question: Name two antiplatelet medications that should be administered
immediately in the emergency setting for suspected MI.
o Answer: 1. Aspirin. 2. A P2Y12 inhibitor (e.g., Ticagrelor, Clopidogrel).
Station 2: Respiratory – Breathlessness
Scenario: A 65-year-old female with a 40-pack-year smoking history presents with
progressive shortness of breath and a chronic cough productive of purulent sputum. On
examination, she has an increased AP chest diameter and uses accessory muscles to
breathe.
6. Question: What is the most likely diagnosis based on the history and
examination?
o Answer: Chronic Obstructive Pulmonary Disease (COPD) with a possible acute
exacerbation.
7. Question: You order a chest X-ray. What are two classic radiographic findings you
might expect in a patient with advanced COPD?
o Answer: 1. Hyperinflation (flattened hemidiaphragms). 2. Bullae.
8. Question: Pulmonary function tests are essential for diagnosis. Which spirometric
ratio confirms an obstructive defect?
o *Answer: A reduced FEV1/FVC ratio (less than 0.7).*
, 9. Question: List two first-line bronchodilators for maintenance therapy in stable
COPD.
o *Answer: 1. Long-acting beta-agonist (LABA) (e.g., Salmeterol). 2. Long-acting
muscarinic antagonist (LAMA) (e.g., Tiotropium).*
10. Question: What non-pharmacological intervention is the single most important
factor in slowing disease progression?
o Answer: Smoking cessation.
Station 3: Neurology – Acute Weakness
Scenario: A 72-year-old male is brought in by ambulance due to sudden-onset
weakness on his right side and difficulty speaking. His symptoms began approximately
45 minutes ago.
11. Question: What screening tool is commonly used in the pre-hospital and
emergency setting for suspected stroke?
o Answer: FAST (Face, Arms, Speech, Time) or the Cincinnati Prehospital Stroke Scale.
12. Question: On examination, you note right-sided hemiparesis and global aphasia.
Which hemisphere and likely vascular territory is affected?
o Answer: Left hemisphere (as language is affected), in the Middle Cerebral Artery
(MCA) territory.
13. Question: A non-contrast CT head is performed and shows no hemorrhage. The
patient is within the window for thrombolysis. What is the major exclusion
criterion related to time of onset?
o *Answer: If the time of symptom onset is unknown (e.g., wake-up stroke) or
greater than 4.5 hours.*
COMPREHENSIVE PRACTICE EXAM
OSKE Practice Exam: 75 Questions
Exam Instructions (For Candidates)
This examination consists of 10 stations. You will have a limited time at each station to
review the clinical scenario and answer all associated questions. Answers should be
concise and demonstrate your clinical reasoning. No external resources or collaboration
are permitted.
Station 1: Cardiology – Chest Pain
Scenario: A 58-year-old male presents to the emergency department with substernal
chest pain that began 2 hours ago. He describes it as "heavy" and radiating to his left
arm. He is diaphoretic and nauseous.
1. Question: Based on the initial presentation, list three most likely differential
diagnoses.
o Answer: Acute Myocardial Infarction (STEMI/NSTEMI), Unstable Angina, Aortic
Dissection.
2. Question: What is the single most important diagnostic test to perform
immediately?
o *Answer: 12-lead Electrocardiogram (ECG).*
3. Question: The ECG shows >2mm ST-segment elevation in leads V2-V4. What is
your diagnosis and immediate next step in management?
, o Answer: Diagnosis: Anteroseptal ST-Elevation Myocardial Infarction (STEMI).
Immediate next step: Activate the cath lab for primary Percutaneous Coronary
Intervention (PCI) or administer thrombolytics if PCI is not available.
4. Question: List two cardiac enzymes used to confirm myocardial necrosis and their
typical peak timing.
o *Answer: 1. Troponin I/T (peaks at 12-24 hours). 2. CK-MB (peaks at 24 hours).*
5. Question: Name two antiplatelet medications that should be administered
immediately in the emergency setting for suspected MI.
o Answer: 1. Aspirin. 2. A P2Y12 inhibitor (e.g., Ticagrelor, Clopidogrel).
Station 2: Respiratory – Breathlessness
Scenario: A 65-year-old female with a 40-pack-year smoking history presents with
progressive shortness of breath and a chronic cough productive of purulent sputum. On
examination, she has an increased AP chest diameter and uses accessory muscles to
breathe.
6. Question: What is the most likely diagnosis based on the history and
examination?
o Answer: Chronic Obstructive Pulmonary Disease (COPD) with a possible acute
exacerbation.
7. Question: You order a chest X-ray. What are two classic radiographic findings you
might expect in a patient with advanced COPD?
o Answer: 1. Hyperinflation (flattened hemidiaphragms). 2. Bullae.
8. Question: Pulmonary function tests are essential for diagnosis. Which spirometric
ratio confirms an obstructive defect?
o *Answer: A reduced FEV1/FVC ratio (less than 0.7).*
, 9. Question: List two first-line bronchodilators for maintenance therapy in stable
COPD.
o *Answer: 1. Long-acting beta-agonist (LABA) (e.g., Salmeterol). 2. Long-acting
muscarinic antagonist (LAMA) (e.g., Tiotropium).*
10. Question: What non-pharmacological intervention is the single most important
factor in slowing disease progression?
o Answer: Smoking cessation.
Station 3: Neurology – Acute Weakness
Scenario: A 72-year-old male is brought in by ambulance due to sudden-onset
weakness on his right side and difficulty speaking. His symptoms began approximately
45 minutes ago.
11. Question: What screening tool is commonly used in the pre-hospital and
emergency setting for suspected stroke?
o Answer: FAST (Face, Arms, Speech, Time) or the Cincinnati Prehospital Stroke Scale.
12. Question: On examination, you note right-sided hemiparesis and global aphasia.
Which hemisphere and likely vascular territory is affected?
o Answer: Left hemisphere (as language is affected), in the Middle Cerebral Artery
(MCA) territory.
13. Question: A non-contrast CT head is performed and shows no hemorrhage. The
patient is within the window for thrombolysis. What is the major exclusion
criterion related to time of onset?
o *Answer: If the time of symptom onset is unknown (e.g., wake-up stroke) or
greater than 4.5 hours.*
